CompTIA
Checkpoint
ISC
HP
Dell
EC-Council
EXIN
Fortinet
ITIL®
Juniper
PMI
Microsoft
VMware
Avaya
Google
Salesforce
Amazon
Palo Alto Networks
Certiport
ISC2
All Vendors
  2. Home
  3. Exams
  4. USMLE
  5. STEP3

Free STEP3 Exam Braindumps (page: 24)

Page 23 of 202
PDF with 804 Questions

A 64 year old woman presents with bilateral symmetric arthralgias and morning stiffness for several years. She says that she has been worked up for RA in the past. On review of her records as well as the examination you note subcutaneous nodules, positive rheumatoid factor, and radiographs of the hands that revealed joint erosions. Which of her findings has the highest positive likelihood ratio (LR) for the diagnosis of RA?

  1. morning stiffness
  2. rheumatoid nodules on examination
  3. symmetric arthralgias
  4. joint erosions of the hand on xray
  5. positive rheumatoid factor.

Answer(s): D

Explanation:

RA is primarily a clinical diagnosis. The history and physical examination are crucial to confirming the diagnosis and ruling out differential diagnosis. No one laboratory analysis can make the diagnosis, however using laboratory analysis in conjunction with a detailed history and examination can help to confirm the clinical suspicion. Some findings that may suggest RA include: morning stiffness (LR 1.9), symmetric arthralgias (LR 1.2), rheumatoid nodules (LR 3.0), positive serum rheumatoid factor (LR 8.4), and radiographic changes of hands/wrists that demonstrate erosions or hypodensity adjacent to the joints (LR
11). Rheumatoid factor is present in about 70% of patients with the diagnosis at some point in the course, however in less than 30% of patients with early RA. ANAmay be positive in 2040% of RA patients but may also be positive in many other disease states. Anti-CCP antibodies have been reported to have a sensitivity of 4070% and specificity of 95%. The presence of both RF and anti-CCP is very highly specific for the diagnosis of RA



A 58-year-old woman is concerned about her risk for osteoporosis and is seen by her general internist. Her mother was diagnosed with osteoporosis and had a hip fracture at age 84. She has no personal or family history of kidney stones or ulcer disease, and she has never had a fracture. She had a hysterectomy at age 48 and took estradiol for 2 years, but discontinued because of a fear of adverse effects. She does not have any vasomotor symptoms. She takes 1500 mg of calcium carbonate and 400 IU vitamin D daily. She is not on any other medications. On examination, she appears well developed and there is no evidence of kyphosis. ABMD test is performed that demonstrates a T score in the spine of 3.5 and in the hip of 2.8. CXR and mammogram are normal. Further evaluation demonstrates the following:



Which of the following is the most likely diagnosis?

  1. milk-alkali syndrome
  2. primary hyperparathyroidism
  3. sarcoidosis
  4. secondary hyperparathyroidism
  5. osteomalacia

Answer(s): B

Explanation:

Primary hyperparathyroidism is common in postmenopausal women and more than 80% present without any symptoms. The most common findings are bone loss, usually in association with estrogen deficiency. The elevated calcium, decreased phosphate, and increased urinary calcium are typical of this disorder. Milk-alkali syndrome is primarily historical disease occurring in patients receiving large quantities of calcium and alkali, and presenting with renal insufficiency, elevated phosphate, and alkalosis. Her normal renal function and relatively low dose of calcium exclude this entity. Familial hypocalciuric hypercalcemia is autosomal dominant and is diagnosed by a low urinary calcium clearance. The lack of renal insufficiency excludes secondary hyperparathyroidism. The normal CXR and Hgb make sarcoidosis and multiple myeloma unlikely. Postmenopausal osteoporosis and osteomalacia are excluded by the elevated calcium level.



Vitamin D supplementation can be helpful in treating which disease?

  1. hyperparathyroidism
  2. hypoparathyroidism
  3. alcoholic neuritis
  4. pernicious anemia
  5. scurvy

Answer(s): B

Explanation:

Vitamin D is actually a hormone that, along with parathyroid hormone and calcitonin, regulates plasma calcium concentration. One action of vitamin D is to increase plasma Ca2+, which can be reduced in hypoparathyroidism. Scurvy is associated with vitamin C deficiency. Alcoholic neuritis is associated with thiamine deficiency.



A34-year-old woman was found to have a 2-cm right thyroid nodule at the time of a well woman examination. The remainder of the thyroid was palpably normal and there were no lymph nodes palpable. There was no history of thyroid disease or radiation therapy to her head or neck. She was clinically euthyroid. Thyroid-stimulating hormone (TSH) was normal. Which of the following tests would be the most useful in establishing a specific diagnosis?

  1. ultrasound of the thyroid
  2. nuclear scan of the thyroid
  3. thyroid antibody studies
  4. fine needle aspiration of the nodule
  5. CT of the neck

Answer(s): D

Explanation:

In evaluating a sporadic thyroid nodule in a patient who is euthyroid, it is critical to determine whether the nodule is malignant or benign. The most diagnostic test is the fine needle aspiration. Ultrasound will only distinguish between cystic and solid structures, and most nodules have some solid component. The nuclear scan will demonstrate a photopenic area in over 85% of patients. Neither these tests nor CT scan will reliably separate benign from malignant nodules. Thyroid antibody studies do not play a role in the evaluation of a thyroid nodule in a euthyroid patient. They are sometimes used in the evaluation of thyroiditis.






Post your Comments and Discuss USMLE STEP3 exam with other Community members:

STEP3 Discussions & Posts